Provider Demographics
NPI:1831535160
Name:MARINO, CHARLES THOMAS
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:THOMAS
Last Name:MARINO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:961 WATER ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78028-3541
Mailing Address - Country:US
Mailing Address - Phone:830-890-5800
Mailing Address - Fax:
Practice Address - Street 1:961 WATER ST
Practice Address - Street 2:SUITE B
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-3541
Practice Address - Country:US
Practice Address - Phone:830-890-5800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-14
Last Update Date:2013-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80435237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX80435OtherSTATE COMMITTEE OF EXAMINERS